Have You Left Money on the Table?

As we discuss the Inpatient Prospective Payment System (IPPS) Proposed Rule for the 2025 fiscal year (FY), I want to call attention to the FY 2024 updates.

There are almost five months remaining in the current fiscal year, and hospitals are looking for money. One place I would like to suggest is Medicare Administrative Contractor (MAC) Implementation File 8. This file lists New Technology Add-On Payments (NTAPs). The NTAP is additional money paid on top of the MS-DRG reimbursement.

There are three tabs that specify New NTAPs, Continued NTAPs from the previous year, and Discontinued NTAPs. Each spreadsheet lists the title of the technology, the maximum add-on payment, the ICD-10-CM and/or ICD-10-PCS codes, and Alternative Pathways Status. Please be aware that this file was updated for Jan. 1, 2024 discharges.

The January update includes DefenCath, which has a maximum payment of $17,111.25. The ICD-10-PCS code that triggers the payment is XY0YX28. This NTAP is an antimicrobial catheter lock solution to reduce catheter-related bloodstream infections.

As you are investigating this addition, I would suggest reviewing all the items on the new and continued tabs with pharmacy, chargemaster coordinator, or the person who manages devices at your facility. There are 20 new NTAPs and 11 continued NTAPs. The additional reimbursement for the current year varies:

• New NTAPs: $850.85-$33,236.45
• Continued NTAPs: $2,535-$44,200.00

In FY 2023, some of the NTAPs were paid an additional $289,532.75.

While looking at the FY 2024 list, you can also download the FY 2025 proposed list of NTAPs. By looking at the proposed list of pharmaceuticals and devices, you can begin to prepare for this October. The FY 2025 list is not finalized, but you can get a jump on your preparation.

Some billing systems can apply the ICD-10-PCS code on the claim. Perhaps your billing system could apply the code for you.

It is important for health information management (HIM) to be active in the revenue cycle processes. Perhaps no one else is aware of the NTAP codes.

It is common for the NTAPs to be overlooked, and that means that money is left on the table.

Programming note:

Listen to senior healthcare consultant Laurie Johnson’s live Coding Report today on Talk Ten Tuesday with Chuck Buck and Dr. Erica Remer, 10 Eastern.

Resources:

https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/fy-2024-ipps-final-rule-home-page#Tables